Cellulosic hemostatic composition



Unit-Cd States o This iiiventiorettes te novel compositions ef matte'aid "to methods for producing" them. `In one of its more speeiiiz" 'as'pe'c't's"thel invention is directed to novel compositions" of matter which serve as excellent hemos'tatic' agentseapable'of 'being absorbed in live animal', tiss''e lii the"v course yof' my work on hemostasis and eiiperimetatio'n in' the 'production of organic compounds, I have' discovered certain derivatives of high molecular weight p'olysacchar'ides,.such as starch, inulin and cellu-'f lose to be admirably suitable for use by the surgeonv .in the eou'rse jof' performing certainv operations on' animals.

I have' discovered that certain cellulose, starch and iiilin'sulphuric acid' compounds` and also certain celluf lose'," starch and nulin" acid ethers' and derivatives of said vcompounds are"speetacularly suitableV as hemostatic agentswlietifus'ed' for this' purpose either' alone, in varionsI proportions' and' combinationsy withjjeach' other, and/ or withv other compounds and materials For the" sake 'of brevity, the invention will be particularly described with' reference to' a particular` polysaccharide, namely cellulose. It is tov be understood that'l in` general, starchror inulin may b'e employed in place-"of Cellulose A, hereinafter identified.

lTh cellulose sulphuric acid compounds of Ithis'invention aveanave'rage o'f"1v to 3 (OSO3H) groups in -place of"y theOHi groupspresent in cellulose which is made up` of a'plurlity- Aof units, each" of which`v` has thev general` tinare the salts of `said-cellulose sulphurie acid com-Y pounds; and! arethe sulphuricV acid compounds wherein the'V H of the (GSO3H) groups has beenA replaced by a metal, such as sodium, potassium', calcium, magriesium, aluiniiiunf andi/or radicals,` such- `as pyridine, qu'in'oli'ne,V ammonium, 'etefandin such instances all or only part, say' l0-'100% of (OSOSH) groups of the cellulosesulphric acid compounds may be converted to the" s 'alt groups, which,.whe'n sodium is the substituent, maybe represented as '(OSO3Na), for the purpose of'illustrauten; t

The cellulose acid either compounds of this invention haveanfavera'ge of 0.5 toy 3.0 v(ORyCOOI-I) groups in placejof the OH groups Apresent in said cellulose units, inWHihR is a CH2 group and y is a whole number ythe rangeof l to 3. "Some derivatives of these cellulose acid ethers are their salts, in which the H of said (ORyCQOH) groups has been replaced by one ofI the aforesaidV metal or organic radicals and, when sodium, may be'represented as (ORyCOONa), and in such instances all or only part, -`l00% of the (ORyCOOH) groups of the acid ethers may be converted to the salt groups.

Mixtures ofcellulose acid ethers and' cellulose sulphuric acid compounds as well as the salts thereof are also within'the purview of this invention as well as compounds in which the cellulose units contain both OSOBH and ORyCOOH groupsv in place of the OH: groups of lice 2,914,444

. Paiented Nov. 2 4, 1959 said cellulose. They also may be in the formt of their blood of animals, they are readily absorbable in normal,V

vhad been oxidized by NO2.

liveanimal tissue and do not cause undue irritation of the tissue or appreciable toxic eiilects. Consequently, these compoundsA may be employed by the surgeon as hemostatic agents in the course of his operation and may be allowed to' remain in the wound after the opj eration has been completed.` f

This-A is a great advance, because heretoforeY it has been the general practice for the surgeon, Y'as he makes an incision, to pack the wound with cotton gauze, put pressure on the bleeding area and'niaintain the pressure for some time until the bloodl clots by the normal process of contact with air. `This requires considerable time arid even'so, usually does riotv completely stop the bleeding. vHe mustfth'en, from time to time during'the op eration, clear the blood from the working area with gfauze Sponges.l When the operation is practically finislie'd aridbefo'refinal suturing, he must remove the gauze from' the wound" which many times results in recurrence of bleeding, and, while rarely, it doesA sometimes happen theordinary gauze and sponges'to take care of the bleeding have' been recognized `f`or many years. One of the attempts which was made` in'an effort yto reduce tofa degree those' disadvantages` was' proposed :some yea'r's ag'o'. This' attempt" involved the use of cellulose whichL Y While this vmaterial hasvbeen found useful, itha's fallen farshort of that Which is4 'required' because of its vseveral singular disadvantages, amongfwhic'h are: i

(lijf 'It is uns-table even at ordinary temperatures.

(2)v It `cannot be sterilized' by the ordinary methods" of heat sterilization. In order to sterilizethat productA itl is: necessary to subject itfto a special treatment with formaldehyde. Its physical `form is not vsatisfactory be-v cause@ it is* in4 the shapeA of cotton or gauze, which whentreated and after treatment has a large number' of interf sticeslfthroughf whieh" bloody may pass andv it may not' b'e' produced 'in the form of a; thin rc'ontinuousiilm' or other more suitable forms; Because of` this, relatively large' quantities must be used.

(-3) It doesf'not adhere'v tol bleeding tissue', and, consequritly, must be held against the bleeding tissue for a certain-period of time so that its hemostatic action will take effect, otherwise it will be washed away by the flew-'of blood. f

("4)Y It isf extremely non-uniform in composition as v evideiieed by thefactthatone portion maybe absorbedv 240.F. for twenty minutesor more.A

by the tissue in seven-days, for example, while an ad? jacent portitinY may' requirek 14 or more days and even' upto 30r 'days' and, moreover, often causes considerable" tissue irritation.

- (5 )f It cannot rbe used to coat or impregnate surgical dressings; 1`

t The 'com'pt`nsi't`ic`1`1's'ofv the present' invention' are 'far superior to said coxripositionsl of cellulose oxidized with NO2 fori the'- following reas'oris:

('15) They are stable for a long period of time at the temperatures normally encountered and therefore,have th'elrequired shelf or storage life.

r(2) 'They can be sterilized by autoclaving them'in sealed containers at a temperature o'f approximately (3) Some of them can be made in a form having excellent adhesion to bleeding tissue and they are nonirritating and non-toxic.

(4) They are uniform in composition and properties. (5) They may be employed to impregnate or Coat surgical cotton, gauze or other woven or matted fabricl which is to be placed immediately over the wound so that the blood which exudes from the wound may be congealed and the bleeding stopped. Consequently, the gauze or textile material coated and/or impregnated with my compositions may be used as the gauze component of an adhesive bandage,.may also be used as a surgical dressing; and also may be used by the surgeon in the course of his operative treatment -as desired; and also asA uterine packing, or in other body cavities after or during an operation. When so employed it is preferable that the gauze or surgical dressing also contain a humectant such as glycerine, sorbitol or various other aliphatic polyhydric alcohols well known for this purpose, in order that the dressing may be released from the bleeding area after the bleeding has been once stopped without starting the bleeding again.

(6) They may be produced in a -wide variety of different physical forms. Some of them may be made up in the form of thin films which may be readily handled and applied to a bleeding area by the surgeon much like the way so-called Scotch tape, for example, is applied to a surface. They may be made up in the form of a film having any desired degrees of porosity. They may be made up in the form of foamy dry materials of the desired thickness. They may be made up in librous forms by'extrusion and drying or in porous forms by drying in the frozen state, or by drying with anhydrous solvents; and the cellulose sulphuric acid compounds particularly maybe precipitated out of concentrated solution in fibrous form and dried. Materials of this nature which adhere strongly to bleeding tissue may be coated with the said humectants on one side so that they do not stick to the.

surgeons blood-covered glove, if desired.

" (7) In all of the aforesaid cases it is possible to have modifying components therein, such as the humectants and also various thickening agents such as pectin, gelatin, etc. and foaming agents such as glyceryl monostearate as well as certain medicaments such as sulfa drugs, aureomycin, etc.

(8) They also may be made up in the forms of gels and pastes for lilling body cavities, for example; and a thick paste, for example, in mixture with polyglycols, may be-used as bone wax to stop the bleeding from bone marrow and also as a covering directly over the wound. (9) These various compositions may be used as im pregnants. and coatings for, as well as components of, the starch and gelatin sponges now used for hemostasis.

(l) In addition, the various compositions of this invention in their acid forms may be mixed as a dry powder with sodium bicarbonate, for example, and insuliiated or otherwise placed into the bleeding cavity. When the dry compositions become wet, gas is evolved causing a foaming of the mixture which iills the cavity and stops the bleeding. These mixtures may also contain any desired medicament, spermaticide or antiseptic, and provide an excellent wayk for spreading a medicament-into a body cavity and might be especially useful for the treatment of vaginal and uterine diseases. c

The sulphuric acid derivatives of cellulose may be prepared in a number of dilerent ways. While others have prepared a sulphuric acid derivative of cellulose, noone has prepared it in such a condition as to be suitable for the purposes intended herein. According to this invention, lI employ as a reactant or starting material that type of cellulose hereinafter known as Cellulose A characterized by having anywhere from 50 to 2000 cellulose units of chain length and represented by the following general formula (C6H7O2(OH)3)$, wherein x is 50-2000 and from which the oils, fats, waxes, proteins,

, phuric acid.

. 4 etc. which may have been present therein have been removed by the usual alkali boiling, bleaching, souring and washing. I may also prefer to use regenerated cellulose.

Said Cellulose A is first reacted with dilute S03 or with SOZCIZ in the presence of a base such as sodium hydroxide to produce the sodium salt of cellulose sul- I prefer, however, to first react said ce1- lulose in dry form with chlorosulfonic acid in the presence of a weak base, such as pyridine ,or quinoline and especially the former and thus produce the pyridine salt of cellulose sulphuric acid. The proportions of reactants, the time and temperature of reaction; the presence of oxygen and moisture are so chosen that the extent of reaction is controlled as to the breaking of the cellulose chains and to obtain the various cellulose sulphuric acid salts, withthe average degree of substitution of the cellulose being up to approximately and as low as desired.` The presence of moisture in the cellulose and in the pyridine should be controlled (desirably below 8%) in'order to avoid hydrolysis of the product and destruction of a portion of the chlorsulfonic acid. In

,l order to avoid degradation of the productA and the forma` 'l tion of low molecular weight materials, oxygen or air l of. 0.5 to 3.0 because such material has the desired solubility characteristics. The resultant reaction mass contains the pyridine salt of cellulose sulphuric acid, pyridine hydrochloride, pyridine hydrosulfate, excess pyri`v dine salt of chlorsulfonic acid, and possibly some unreacted cellulose.- This mass is added to a dilute aqueous solution of an alkali such as sodium hydroxide, sodium carbonate (or calcium hydroxide or the like), whereupon the pyridine cellulose sulphuric acid is converted in large part to the sodium salt and most of the pyridine separates out as av top layer. Other salts, such as thepotassium, calcium, magnesium, barium, ammonium, etc., maybe produced in a similar manner. More concentrated NaOH can be added at this point in order to more completely separate the pyridine,.keeping the mass cool in order to prevent decomposition of the product This top layer is Completely removed to recover the pyridine, and the remaining bottom layer consists of van aqueous solution or dispersion of sodiumvcellulose sulphate togetherwith sodium chloride, sodium sulfate, sodium hydroxide and may contain some slight amount ofu unreacted cellulose and some pyridine.

At this stage this lower layer may be treated in a number of different ways,some of which are as follows:

(A) A quantity of ethyl alcohol, propyl alcohol, iso-l propyl alcohol, acetone, or other organic liquid which is water soluble and has a low solubility factor for the sodium salt of cellulose sulphuricy acid, may bevadded thereto in quantities sutcient tov cause precipitation out of the sodium salt of cellulosek sulphuric acid. Alternately an excess of NaOH maybe added in order toprefer to treat it with alkali as described in order to re-' cover the pyridine to be dried for re-use.` In adding precipitants, it is Edesirable not to use so much as to precipitate a large part of the NaZSO.,t with the product, since this salt is not' very soluble in mixtures of organic solvent and water and is difficult to remove later.

(B) The mass is now decanted or filtered and must then be freed of pyridine, Na2SO4, NaCl, etcjby one or more of `several methods.' It may be washed with' organic solvent-water mxturesby-'decantation or filtering. However, it may at this point be precipitated in the acid for'm with HCl and washedwith hydrochloric acid and alcohol in order to remove the inorganic salts. Finally, it may be washed with alcohol or alcohol-water mixtures toiremove the HCl. It may be dried with strong alcohol (95% or absolute), followed by drying in a vacuum dessicator. If at any point during the washing the product becomes difficult to settle or filter, it may be washed with strong alcohol which Iwill give a dense, compact solid. If the product contains insoluble, unreacted cellulose, a quantity of water may be added and the cellulose settled out and removed. However, it is entirely unnecessary to have any unreacted cellulose present.

The dried product after having.. a small amount of water added thereto i's a viscous mass, known as Product X, and may be spread in the form of films on a glass plate and dried. Care shouldbe taken in the `drying operation which is dependent for its time upon the thickness of the film and also the humidity and temperature of the atmosphere in which the dryingtakes place. The drying is stopped when theiilm,-while still containing a small proportion of water, isfirrnand dry to the touch, is resilient and flexible and is notbrittle when bent over on itself over approximately a 360 arc. I-,find also that these films may be plasticized with liquidaliphaticpolyhydric alcohols, such as, glycerol, glycols, sorbitol and similar compounds, aswell as with water.

Instead of washing the precipitated sodium salt with alcoholand water asy set forth in step-B, this precipitate may have' a small proportion of water' added thereto with or Kwithout a small proportion ofrconcentrated hydrochloric acid and placedon one side of a dialyzer to be .purified by dialysis; The dialysis is stopped at the' point where the pH of said mass is the range of about 2;#6 as desired. This purified mass, as before, may be con-V verted to the film form; preferably from thel vacuumevaporated dialysate.

By employing the aforesaid methods there may be produced novel'cellulose sulphuric acid compounds and salts thereof in various combinations and degrees of substitution. v

The cellulose sulphuric acids consist? of` cellulose Whose OH' content has been replaced by (OSOSH) and the salts thereof, as for example the sodium salts-are' cellulose whose OH content has been replaced by4 (OSOZNa) and, as before-'pointed'ouu the average degree of OHisubstitution may be in limits of 0.5 to 3 per cellu-v lose unit. Such compounds are stable esters resistant` to the action oflacid or alkali.

TheV thickened mass, Product X, however produced, may be thinned to any desired degree of viscositywith distilled water; to rendery it suitable for coatings and irnpregnations. The gelatin or starch Sponges may be dipped in this solution andv then dried until the film' thereon ofthematerial is firm, resilient and dry tothe touch. Or,..rny hemostatic material may be' included in the solution from which the-se Sponges are made. In

any of these cases aquantity ofthe desired humectant and/or medicament may be added thereto. When a foam or' a gel is desired,-I may prefer to'first thicken the cellulose sulphuric acid, with or without its sodium salt, lwith sodium carboxymethyl cellulose, gelatin, pectin or etc. and/ or a foaming agent to form a thickened mass in the nature of a paste; and then this may be used by itself or may be agitated andwhipped to produce a foam and in either case is dried to the rm, resilient, dry-to the-touch state. If desired, the films Vmay contain a small proportion of either sodium chloride or urea or other watersoluble, non-toxic solid not soluble in the cellulose sulphuric acid, to increase the water absorbency of the film, and consequently, when yplaced upon bleeding tissue the blood will be absorbed faster into the film where-l itmay be readily 'K conge'aled;` Afterithef massi is Whipped into a foamv itmay'be driedat' ordinarytem" v way ay porous sponge is obtained. If desired; thesolubility may be decreased by heating or iten'sive'drying, but normally thisi's not necessary.v

Product X is converted to the fibrous state in a simple manner. In a` concentratedv aqueoussolution ofv Pr'o'duet X there may be added alcohol or HCl which caus'esthe cellulose sulphuric acid to precipitate out' in the fibrous; form simulating asbestos fibers in appearance. The liquid is then decanted andthe remaining fibrous precipitate is washed two or three' times with alcohol iii order' to dehydrateit to' the' extemthat' the bers do not sti'ek together and ball up in a mass', and yety sufficient water'l remains so that the fibers are plasticized to the^desired degree. If the degreeof plasticization desired is not achieved, the fibers may be placed in a vessel containing water kvapor andallowed to remain therein'until' suicient water has become absorbedfthereby. e

I nd that the stability of my products" toward heating is"va`riable. In general, I find that the dialyzed product' is less stable than the precipitated and washed products. This may be due to a' number of causes: (1') the evapora tion of the dialyzed solution'may'cause some decomposif tion, (2) the dialysis may not eliminate some' unstable ingredient that' isr removedin washing. Ivfind that addi# tion of certain materialssuch-as urea, ascorbic acid, etc. increases the stability of my products. l v

These materialsmay be sterilized either by heat or by various antiseptic materials such as formaldehyde, ethyl# ene oxide, propylene oxide, at'low'tempea'tues' in the presence of minimal amounts of moisture'. They 'r"i" a`y".,y also be sterilized by warming with mercrial, phenolic, or other antiseptic materials.Y y

Thev following are s'peciii'cy examples illustrating" some' of the methods of preparationY I have used to produce certain illustrative products of thisy invention:

72 cc. of chlorsulfonic acid wasadded to' 280 'C,c.1ofl cold pyridine. The product was heated to 100 C. in a glass-stoppered fiask and 13.5 g. surgical cotton was added intufts. The mixture was heated at 100 C; withoccasional shaking for l hr. 15 min;y -Thenthe resultant' mass (2) was poured into 500 cc. cold water. and stirredf until all lumps were dispersed. The cellulose? sulphuric-v acid pyridine salt solution (A) soV formed is precipitated with a solution of CaClg toforin the calcium salt yof cellulose sulphuric acid- (B).l The product (A) does not precipitate with- NaCl solution'for" co'ncen'trated A portion of the calciumI chloride precipitate (B1) was acidified with HC1 and dialyzed through a cellophane* membrane into pure water until no test for Cl was obtained. The product (B) slowly dissolves during dialysis and the dialyzed solution gives a occulent" precipitate with alcohol. The product (A) when dissolved i'n conc.v HC1 gives a fibrous precipitate with alcohol as does'also' the product (A) alone. Addition of 50% NaOH'tot) gives a curdy precipitate and separation of pyridine. (A)l was precipitated with strong NaOH, the pyridine separated, the precipitate acidified` with HC1 andV dialyzed. The dialyzed solution" gives av curdyi'p'e'cfipitate with .al, cohol and ether. After vacuum evaporation,'the dialyzedV solution gives a fibrous precipitatewith alcohl'and'fether. The precipitate compacts withl stirring, is hygroscopic and soluble in HCl; however, if it is first dried by washing with alcohol, it doesv not'fcoinpact vand gve'stadryifibrous matte. f

Examplell A mass (2), similar to that of Examplel, wastreated withfsolid NaOH. Heatingl occurred during stirring'withf the NaOH and a product was obtained that dialyzed* very quickly g after acidification with HCl and a large partof the product passed through the dialysis membrane.

Example III l 93 cc. of chlorsulfonic acid was added to 350 cc. cold pyridine and then 17 grams of tufted surgical cotton was added thereto and the mass was heated for 11/2 hrs. at 100??k C. The reaction mixture was then poured into 500 cc. cold H2O and stirred until completely dispersed. The cold mixture was slowly mixed with 1300 cc. of an aqueous solution containing 150 g. NaOH. 215 cc. of thick jelly formed on the bottom, the top layer was essentially pyridine and the middle layer contained some pyridine but was mostly lWater and salts. The jelly layer was separated from the other layer and conc. HCI added to the jelly, giving a thick, white gum. A dispersion of the acid gum was dialyzed and the product vacuum evaporated.

Example IV A reaction mixture similar to that of Example III was poured into 500 cc. cold H2O, cooled and mixed with 150 g. NaOH in 525 cc. of water. A lower layer of 890 cc. is formed with a top layer of mostly pyridine. After v acuum evaporating the lower layer, it was precipitated with' alcohol, filtered and washed with alcohol to remove residual pyridine and dissolved in Water. The solution was acidiied withHCl and dialyzed. There were large amounts of salts in the alcohol precipitate.

Example V was separatedfrom the pyridine layer and precipitated with insuiiicient alcohol to precipitate the inorganic salts present. Washing with alcohol-water mixture gives a tough, pulpy, sticky mass that dries out hard on the surface and contains no considerable amount of pyridine. A concentrated water solution of the product gives a iibrous, cotton-like product with conc. HCl that is not sticky when dry. It may be spread out into a sheet like cotton. It absorbs water like absorbent cotton. lt can be stored unchanged in an alcohol-water mixture. Part of the sodium cellulose sulphate was acidied with HC1 and dialyzed to a nal pH of 2.2.

Example VI L35 grams surgical cotton heated 11/2 hrs. at.100 C. with a mixture of 6.5 cc. chlorsulfonic acid and 28 cc. pyridine gave a very water-soluble product in the form of the' pyridine salt of cellulose sulphuric acid.

Example VII 3 grams surgical cotton heated 1% hrs. at 100 C. with 3 cc. chlorsulfonic acid in a large excess of pyridine (100 cc.) gives a product less soluble than that of Example VI.

Example VIII 3A grams of surgical gauze heated 1.7 hrs. at 100 C. with 3.4 cc. of chlorsulfonic acid in 35 cc. pyridine, gives a product with the gauze structure remaining, but the gauZestructure disappears upon standing in water overnight.

Example IX 4 grams of` surgical cotton heated 11/2 hrs. at 100 C. with 2 cc. chlorsulfonic acid in 45 cc. pyridine, gives a relatively water-insoluble product.

Example X Example XI The sodium cellulose sulphate as obtained in Example IV was treated as follows: 50 g. of the salt plus 143 cc. water plus 57 cc. HC1 gave a white, gelatinous precipitate. To this was added 143 cc. conc. HC1 plus 214 ce. 95% alcohol. The product was filtered and Washed with 143 cc. conc. HC1 in 214 cc. 95% alcohol. The product was further Washed with 50-50 alcohol-water until no est for Cl or S04 was given by the Washings. The product was then dried with absolute alcohol and placed in a vacuum dessicator overnight. 15 grams of dry product was obtained, which was somewhat glue-like on the surface. This product was dissolved in 30 cc. water, giving a very viscous solution. The solution was dried on a glass plate in air to give a strong, iivexible film which had excellent adhesion and hemostatic action when applied to bleeding animal tissue. This film could be heated at 100 C. for 1%/4 hrs. without noticeable deterioration.

Example XII A product similar to that of Example XI was dissolved in just enough water to give a very viscous solution. This solution was beaten into a froth and dried in a vacuum dessicator to give a porous, spongy mass. Another portion was frozen and dried in a high vacuum to give a. similar product.

Example XIII A product similar to that of Example XI was dissolved in water and impregnated into surgical gauze to give a pickup of 12% based on the dry material. This product was then impregnated with 18% glycerin. The material had excellent hemostatic action in bleeding animal tissue and could be removed from the clot without renewal of bleeding. Other similar products were made with 8 to 15% cellulose sulphuric acid and 15 to 25% glycerin.

Example XIV An impureV sodium cellulose sulfate prepared according to Example III and containing much Na2SO4 and NaCl was treated as follows: grams of impure salt was dissolved in 229 cc. water. To this was added, with stirring, 91 cc. of 37% hydrochloric acid followed by a solution of 229 cc. 37% hydrochloric acid Vin 342 cc. absolute alcohol. After thorough stirring, the mixture was filtered on a fritted glass filter. It was washed on the filter with a solution of 344 cc. conc. HCl dissolved in 513 cc. alcohol. After washing with 1500 cc. of 50-50 alcohol-water solution, the product was free of Cl and S04. It was dried by washing with 700 cc. absolute alcohol and placed in a vacuum dessicator. The pure, dry product weighed 27 grams. It formed a strong, stable film when a solution of it was dried on a glass plate in air. The loss in weight during purification represents the Weight of inorganic salts removed plus the weight of low molecular weight materials present in the cellulose sulphate compound, the elimination of which is desirable from the standpoint of purity, stability and strength of tilms made from solutions of the product.

Cellulose glycolic acid ethers have also been produced prior to my invention, but not in condition useful for the purpose of this invention. They may be produced in the form of the sodium salt by reacting alkali cellulose with a solution of chloracetic acid or its sodium salt. The compounds of the prior art have always contained a proportion of material insoluble in animal tissue. This is presumably either unreacted cellulose or cellulose that has been reacted too far; or it may be cross-linked" material; that is, material in which the cellulose units have been bound together by esterication or by the formation of so-called lactone rings.

For some time products known as sodium carboxymethyl-cellulose have been on the market. I have converted such products to the acid form and found theml g. to be inadequate for my purpose becausev of the undue irritation. caused by the presence in them of materialinsoluble inA animal tissue. My methods for making these acid ethers are as follows: v

To alkali cellulose or a dispersion thereof produced with' Cellulose A, preferably regenerated cellulose of low degree of polymer-ization, I add a solution of chloracctic acid or its sodium salt, preferably adding it in successive smallportions and allowing time for each portion to react before adding the succeeding portion. I use proportions of alkali cellulose and chloracetic acid such as to give mea degree of substitution between 0.5 and 2.0; that is, that the number of substituted' ether groups present for each cellulose unit' of the cellulose is between 0.5- and 2.05; that is, that the number of substituted ether groups present for each cellulose unit of the cellulose is between 0.5 and 2.0. If there is present material with too high a degree of substitution, I may precipitate it from aqueous solution in the form of the calcium, zinc or barium saltt I prefer to use aV considerable excess of alkali lin the reaction and to use sodium chloracetate in order to avoid local reduction of alkalinity and to assure no cross-linking by means of esteriication. I may also prefer to use low temperatures (for example, near C.) in order to avoid the formation of lactone bonds. I may also add some ZnO to the alkali which I use toorm alkali cellulose, in order to obtain more complete` conversion to alkali'cellulose.r Moist, regenerated cellulose of low degree of polymerization (for example, 100 to 800) is also desirable for the same reason.r I may also use cellulose thatv has been dispersed at lo'w temperature with concentrated phosphoric acid or HCl, after precipitation of the so-dispersed cellulose by dilution` with Water, Washing and dissolving in NaOH. I may alsoV precipitate alkali cellulose with alcohol or other precipitant in order to remove the cellulose that has not been completely converted tok alkali cellulose. In order to obtain'a clear dispersion of alkali celluloseI-may treat cellulose (preferably of low D P. or moist regenerated cellulose) with strong NaOH at'low temperatures. I-may also use/the product of reaction of cellulosev with a solutionl of sodium in* liquid ammonia. In place of NaOH, I` may use the quat'ernary ammonium bases such asth'e tetra alkyl'ammoniumhydroxides' or the quaternary phospho'nium bases or lithium hydroxide. Another method ofi removinginsoluble material is' to letV a `solution` of sodium c'arboxymethyl cellulose stan'd at about 75 :C. for several days or at room temperaturefor several weeks, at which. point the solution 'will have thinned and much insoluble material precipitated. If desired, smallam'ounts of iron, manganese, or other heavy metal salts may bea'd'dedin order to' accelerate the degradation. The clear solution maythen' be fractionatedl by alcohol, alcohol-HC1, salts; etc'. ormixturesof these in order` to separate out a product of'the desired degree of polymeri-v zatio'n. I may also'd'estroyV anyester linkages o'r lactone bonds: byy warmin'g'theproduct in alkaline solution. v

Another method I' have use'd is' to" precipitate the sodium' carboxymethyl cellulose from dilute solution (by alcohol, for example) thus, obtainingv a colloidal solution from; which the insoluble material may be separated by sedimentationy or centrifuging. Low molecular weight material can be removed' by passage overcertain ion ex'- chang'e resins; In place of1 cellulose Imay use starch or inulini Otherwise, I may remove the soluble material A from' the insoluble material by partially dissolving' the crude'material, in Water or alkali solution thus separating the soluble material from insoluble material. In' this manner the'insoluble material, when the mass is allowed to stand, will fall tothe bottom and the dispersion or solu-' tion'thereabovefmay be ydecanted therefrom and is free from the insoluble component. In any case, and how'- ever produced, this substantially pure sodium salt is now converted to the acid form by treating in one of three Waystl 'f (1) By acidifying, for example', withhydrochlorieaoid or hydrochloric acid and alcohol' and'vdialyzingr tore# move the excess acid andsodiumV chloride; or

(-2) By contacting. the solution' with an ion exchange resin which isA in the acid form; or

(3) The aciditled material may' be washed with water and/or water-alcoholamixtures instead of dialyziug it.

In dialyzing the materialtthe processl may be stopped at the point where any desiredl pH is reached' correspond` ing to any desiredy proportions of acid and salt form or the amount of hydrochloric acid employedv in number one may be such that the degree of conversion is between 100 percent-20 percent'. In fact the sodium salt' may be converted to the acid form by dialyzing without acidification. Films which are dry to the touch,flexible andnonbrittle as well as Sponges, etc. may be madea's'before' the latter by whipping up viscous solutions in air,'freeze be readily handled by the` surgeon for their intended purpose. Asa matter of fact, if they are applied directly to heavily bleeding tissue/they tend to shrivel thereat; I have discovered that they' may be converted to' useful materials for their intended purpose by heating; them. or drying them with alcoholv and/or in dry air so that their water dispersible or soluble factor is considerablyA reduced. They may even become relatively insoluble if this treatment is intensified.-

Since the cellulose glycolic acid ether compounds do not adhere tofbleeding tissue as' well as do the cellulose sulphate compounds, I prefer to use the former in the form of ay porous sponge. I may, however,.modify this property as well as the solubility characteristics byk add-v ing cellulose sulphate compounds to the celluloseglycolic acid ether compounds. f

The'A following examples illustrate some of the methods I have used in making hemostatic compositions of cellulose glycolic acid ether:

A 3% solution of commerical high viscosity sodium carboxymethyl cellulose was acidied with HC1 and dialyzed until no further testfvvas given for Cl. The fe; sulting solution was spread on a glass plate to dry in the air` overnight. A flexible, clear filmA was obtained. This hlm shriveled immediately upoircontact With water. However, when heated for one hour at 100 C., the film wasrelatively insoluble in water. The produce had good hemostatic action ,but did not adhere'tobleedingtissue aswell-as did-the cellulosesulphuric acidlm'. A similar dialyzed' solution was Vacuum evaporated andwhipped into a foam with air. The product, after drying, gave `a porous sponge. similar solution was frozen anddriedv inafhigh vacuum, giving asimilar spongy product.

' Example XVI A 3% aqueous' solution of commercial high viscosity carboxymethyl cellulose, which acttially is sodium' salt, was kept at'about 75 C. for several days until it had thinned out considerably and contained a precipitate of fibrous material; Then the brous material is removed and theA resultant solution and theoriginal solution were heated separately at 100 C. for tive-seven days; The original material contained? a precipitate ofrtibrousl materialvwhile the aged product did not.v The aged product", after precipitation with alcohol and HC1 gave a dried* iilm with good hemostatic properties.

These ethers accordingV to this invention are thus'couvertedby aging at temperatures which may'b'e quite high' andalso at temperatures below the C. set'forth in' Example XVI. Ofcourse, under lower temperature conditions the time of aging will be longer, for example, whenithe: aging@isfearriedfou'tI ati 25 time Will be? temperature are so chosen that the degradationmay take place to cause Aa precipitation and a decrease of viscosity of thesolution afterwhich, of course, the precipitate is removed. In any case, the aged products are capable of being maintained at 100 C. `for ve days without any appreciable precipitate being formed in that period.

' While the cellulose sulphuric acid or the cellulose glycolic acid ether may be used'alone, it is also Within the purview of this invention to employ them in combination with ratio of the former to the latter by weight being about to 95 to 95 to 5 and preferably in the range of 8O to 20 to 50 to 50. The ether in these combinations may be in either the highly or the lesssoluble form, depending upon what is required. It is also within the purview of this invention to employ combinations of cellulose sulphuric acid and/or the sodium salt of cellulose sulphuric acid and the highly or less soluble cellulose glycolic acid ether and/or its sodium salt.

- These combinations p ermit a liner control of viscosity and solubility as well as adhesion to animal tissue.

Still another class of compounds which are suitable for the purpose of this invention are the sulphuric acid esters of the cellulose glycolic acid ethers. These may be produced by rst producing,f these ethers in low degree of substitution, drying, and then treating with chlorosulfonic acid in the presence of pyridine, etc. These compounds may be puritied as before, and may be employed in combination With the other hemostatic compounds of this invention in the ratio by weight of 10-90 to 90-10.

I may also, in certain instances, use other cellulose derivatives, such as the phosphate esters of cellulose or the cellulose phosphoric acid compounds, formed in ways analagous to those used to make the cellulose sulfuric acid compounds. I may also use the soluble hydrated cellulose materials formed by treating cellulose with very strong hydrochloric acid at low temperature, washing the precipitate formed by diluting the dispersion with water and keeping the washed product in a moist but not Wet condition. Such hydrated cellulose may be made slightly acid with a weak acid such as acetic acid or impregnated with a slightly soluble acid or an acid salt such as ferrie chloride. In certain cases vI may use cellulose glycollic acid ether and/or cellulose sulfuric (in mixtures with each other and/ or their salts), particularly in the form of highly porous Sponges of very low. density, as packing material for wounds and/ or as absorbable carriers of medicaments, antiseptics, antibiotics, spermaticides, etc. For this purpose their hemostatic properties may be reduced, for example, by using a considerable proportion of their salts, for example their sodium salts. The presence of their sodium salts will alsoincrease their rsolubility and, as previously stated, may be used to control their pH in order to obtain maximal acceptability in the tissues and to provide -a suitable environment for the medicament, etc. used. For example: a spermaticide may require an acid environment; use on the skin or in the vagina may likewise be more compatible with an acid reaction; certain antibiotics, as for example aureomycin, may be more stable in an acid environment or may exist inthe packing material or dressing as the salt of the cellulose glycolic acid ether or the cellulose sulfuric acid or as the hydrochloride or other salt of the organic base of aureomycin. I may also use such compositions as coatings or impregnants in cotton, gauze, etc. or as ointments, pastes, etc. with aqueous or non-aqueous materials such as vegetablegum, methyl cellulose, polyglycols (carbowax), or petrolatum.

I may also use alginic acid as a raw material in producing hemostatic compositions. While sodium alginate (algin) and calcium alginate have previously been proposed, I use alginic acid which I prepare by the methods described herein and in the special forms I have describedv in connection 'with the preparation of acid forms 1'2 of carboxymethyl cellulose and cellulose sulphate. Especially, I may age aqueous solutions of the very viscous alginic acid in order to eliminate insoluble material and produce material of suitable molecularI weight. 'Alginic acid Vis especially suitable as a hemostatic agent, in the form of an absorbent fibrous matte or a porous sponge. I may also carboxymethylate alginic acid orsulphate it with pyridine and chlorsulfonic acid to form glycollic acid ether or sulphate derivatives of alginic acid; since alginic acid has only one carboxyl group per cellulose unit.

All of the various compounds and combinations of compounds of this invention may also be employed as coatings on and also as impregnants in cotton gauze or the like, either with or without humectants and/ or medicaments and/ or urea, etc. In the use of cellulose or regenerated cellulose (cotton, gauge, viscous rayon, paper,

etc.) backing materials or carriers impregnated or coated with my hemostatic compositions, I may choose to make the cellulose itself slowly absorbable in animal tissue as follows. I partially oxidize the cellulose with oxidizing agents such as permanganate, hypochlorite, hypobromite, hydrogen peroxide, chlorite, NO2, etc. to an extent where a certain amount of oxidation of the cellulose takes place and so-called reaction centers are produced, but not enough to destroy the strength and form of the material.

I then impregnate the cellulose with a solution of a metal salt of iron, cerium, chromium, manganeseetc. and precipitate the metal in the bers ofthe cellulose with alkali to yield the insoluble oxide, hydroxide, or hydrated oxide of the metal. The impregnated cellulose is then thoroughly washed with distilled water in order to thoroughly peptize the material throughout the cellulose. I then have the cellulose partially oxidized and impregnated with an active oxidation catalyst so that if left in animal tissue the cellulose backing itself will slowly degrade and dissolve through the action of the oxygen in the tissue uids, during the course of days, weeks, or months depending upon the extent to which the cellulose is oxidized originally. I may prefer to oxidize and impregnate the cellulose in the form of a dispersion (for example, a dispersion made at low temperatures in strong HCl) in order to obtain thorough and uniform treatment. I may oxidize and impregnate with oxidation catalyst in the same operation. For example, I dip an air-dry regenerated cellulose cloth or gauze into a solution of potassium permanganate and ferrie chloride for several minutes at room temperature, then pad it in a dilute solution of NaOH in order to precipitate the insoluble hydroxides of manganese and iron (the amounts of dry hydroxide being up to a few tenths of a percent of the weight of dry cloth) and then wash the cloth thoroughly with distilled water. If the cloth has lost considerable strength in the process, coating or impregnating 'it with cellulose glycolic acid ether and heating to insolubilizc the ether will greatly improve the strength of the cloth. Or, I may coat or impregnate the cloth with a neutral solution of sodium carboxymethyl cellulose and then precipitate in the cloth the insoluble iron carboxymethyl cellulose by treating with an iron salt solution. In fact, these treatments greatly improve the normally poor wet strength of regenerated cellulose fiber. The cloth or paper so treated may be further impregnated or coated with one of my hemostatic materials. Thus, when and if such materials or bers from them are left in the wound, they eventually dissolve. I may use such oxidation methods and catalysts to increase the rate of absorption of my hemostatic materials themselves. In storage, however, I may use a soluble anti-oxidant like ascorbic acid to preserve them until they are placed in animal tissue when the soluble anti-oxidant is dissolved out in the tissue fluids. They may all be sterilized as indicated for the cellulose sulphuric acid compounds. vThe impregnated products will usually be sterilized in contact with steam',l in which case even though the impregnating compounds 13 melt, they will still remain adherent to the cotton or auze.

g For some purposes, for example where I wish to use my compounds in surgery as materials which adhere to bleeding animal tissue and persist for some time, I may wish to have them only very slowly soluble. This I do by cross-linking the compounds, for example, through reaction with epichlorhydrin, esterication of the acid forms with polyhydric alcohols, or by reaction with formaldehyde.

I may also wish to separate out from my compounds products within certain molecular weight ranges. This I do by fractional precipitation with alcohols or HC1, or lby fractional solution in water or alkali solution, or by fractional precipitation as sodium, calcium or other salts.

While I have described certain methods of producing the materials of the present invention, it will be evident that considerable modification and variation of my methods can be made'without departure from the spirit of my invention.

By cellulose sulphate `ester or sulfuric acid ester of cellulose I mean either cellulose hydrogen Isulphate or the acid form. Cellulose sulphate esters produced by the reaction of cellulose with chlorsulphonic acid is preferred -for the purposes of the invention rather than that made with sulfuric acid.

I claim:

1. A sterile hemostatic material selected lfrom the class consisting of a partially hydrated high molecular weight cellulose glycol-lic acid ether and a cellulose sulphuric acid ester non-toxic and non-irritating in animal tissue, said material being in solid form dried to the extent that it does not quickly shrivel or dissolve in water at 100 F. but insuiicient to become brittle, said material having the physical characteristics of substantial capillary porosity so that it is quickly wet by, absorbs and coagulates the blood of mammals, said product being substantially free of material which quickly dissolves in water on contact and contains no substantial amount of material which is not absorbed in the tissues within a thirty-day period.

2. A sterile hemostatic material comprising partially hydrated high molecular weight cellulose glycollic acid ether in solid form dried to the extent that it does not quickly shrivel or dissolve in water at 100 F. but insui- 14 cient to become brittle, said material having the physical characteristics of substantial capillary porosity so that it is quickly wet by, absorbs and coagulates the blood of mammals, said product being substantially free of material which quickly dissolves in water on contact and contains no substantial amount of material which is not absorbed in the tissues within a thirty-day period.

3. The product of claim 2 having the physical form of a porous sponge.

4. 'Ihe product of claim 2 wherein cellulose sulfuric acid ester is used in place of the cellulose glycollic acid ether.

5. The product of claim 4 in the form of a porous sponge.

6.l A hemostatic product composed of a mixture of the products defined by claims 2 and 4.

7. The product of claim 2 in the form of a film.

8. The product of claim 4 in the form of a film.

References Cited in the file of this patent UNITED STATES PATENTS 1,734,291 Gebauer-Feulnegg Nov. 5, 1929 2,025,073 Rigby Dec. 24, 1935 2,163,588 Cornish June 27, 1939 2,484,637 Mattocks Oct. 11, 1949 2,508,433 Synder May 23, 1950 2,517,772 Doub et al Aug. 8, 1950 2,559,914 Frank July 10, 1951 2,591,742 Thomas Apr. 8, 1952 FOREIGN PATENTS 603,571 Great Britain June 18, 1948 490,432. Great Britain Aug. 15, 1938 428,839 Canada July 17, 1945 OTHER REFERENCES Marks: I. Missouri M. A., December 1948, pp. 894- 895.

Blaine: Annals of Surgery, January 1947, pp. 102-106. Ott: Cellulose and Its Derivatives, 1943, pp. 663-665 and 784-787.

Heuser: Cellulose Chem., 1944, pp. 167-172 and 282. Piper: Acta Pharmalogica et Toxilogica, vol. 2, June 21, 1946, pp. 13S-148. 

1. A STERILE HEMOSTATIC MATERIAL SELECTED FROM THE CLASS CONSISTING OF A PARTIALLY HYDRATED HIGH MOLECULAR WEIGHT CELLULOSE GLYCOLLIC ACID ETHER AND A CELLULOSE SULPHURIC ACID ESTER NON-TOXIC AND NON-IRRITATING IN ANIMAL TISSUE, SAID MATERIAL BEING IN SOLID FORM DRIED TO THE EXTENT THAT IT DOES NOT QUICKLY SHRIVEL OR DISSOLVE IN WATER AT 100* F. BUT INSUFFIENT TO BECOME BRITTLE, SAID MATERIAL HAVING THE PHYSICAL CHARACTERISTICS OF SUBSTANTIAL CAPILLARY POROSITY SO THAT IT IS QUICKLY WET BY, ADSORBS AND COAGULATES THE BLOOD OF MAMMALS, SAID PRODUCT BEING SUBSTANIALLY FREE OF MATERIAL WHICH QUICKLY DISSOLVES IN WATER ON CONTACT AND CONTAINS NO SUBSTANTIAL AMOUNT OF MATERIAL WHICH IS NOT ABSORBED IN THE TISSUES WITHIN A THIRTY-DAY PERIOD. 